期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 197, 期 1, 页码 56-65出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201704-0692OC
关键词
computed tomography; chronic obstructive pulmonary disease; chronic obstructive pulmonary disease progression; emphysema; small airway disease
资金
- Canadian Institute of Heath Research (Rx&D Collaborative Research Program Operating Grant) [93326]
- Respiratory Health Network of the Fonds de recherche du Quebec - Sante (FRQS)
- Canadian Respiratory Research Network
- Canadian Lung Association/Canadian Thoracic Society
- British Columbia Lung Association
- AstraZeneca Canada Inc.
- Boehringer-Ingelheim Canada Inc.
- GlaxoSmithKline Canada Inc.
- Merck
- Novartis Pharma Canada Inc.
- Nycomed Canada Inc.
- Pfizer Canada Ltd
- Canadian Institutes of Health Research Banting Program
Rationale: Studies of excised lungs show that significant airway attrition in the quiet zone occurs early in chronic obstructive pulmonary disease (COPD). Objectives: To determine if the total number of airways quantified in vivo using computed tomography (CT) reflects early airway-related disease changes and is associated with lung function decline independent of emphysema in COPD. Methods: Participants in the multicenter, population-based, longitudinal CanCOLD (Canadian Chronic Obstructive Lung Disease) study underwent inspiratory/expiratory CT at visit 1; spirometry was performed at four visits over 6 years. Emphysema was quantified as the CT inspiratory low-attenuation areas below 2950 Hounsfield units. CT total airway count (TAC) was measured as well as airway inner diameter and wall area using anatomically equivalent airways. Measurements and Main Results: Participants included never-smokers (n = 286), smokers with normal spirometry at risk for COPD (n = 298), Global Initiative for Chronic Obstructive Lung Disease (GOLD) I COPD (n = 361), and GOLD II COPD (n = 239). TAC was significantly reduced by 19% in both GOLD I and GOLD II compared with never-smokers (P < 0.0001) and by 17% in both GOLDI and GOLDII compared with at-risk participants (P < 0.0001) after adjusting for low-attenuation areas below 2950 Hounsfield units. Further analysis revealed parent airways with missing daughter branches had reduced inner diameters (P < 0.0001) and thinner walls (P < 0.0001) compared with those without missing daughter branches. Among all CT measures, TAC had the greatest influence on FEV1 (P < 0.0001), FEV1/FVC (P < 0.0001), and bronchodilator responsiveness (P < 0.0001). TAC was independently associated with lung function decline (FEV1, P = 0.02; FEV1/FVC, P = 0.01). Conclusions: TAC may reflect the airway-related disease changes that accumulate in the quiet zone in early/mild COPD, indicating that TAC acquired with commercially available software across various CT platforms may be a biomarker to predict accelerated COPD progression.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据